Surgical removal of both the humeral and ulnar components of a total elbow prosthesis, including debridement and synovectomy when performed during the same operative session.

Verified May 8, 2026 · 5 sources ↓

Medicare: $1,148.32
Total RVUs: 34.38
Global, days: 90
Region: Elbow

Drawn from CMSAAPCEmedny

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 5 cited references ↓

Operative note must identify both the humeral and ulnar components as removed — documenting only one component does not support 24160.
Note whether debridement and/or synovectomy were performed; if so, describe extent and tissue involved.
Indications for removal (e.g., aseptic loosening, periprosthetic infection, implant failure) must be stated and linked to diagnosis codes.
If an antibiotic spacer was placed at the same session, document it as a distinct surgical step with its own clinical rationale.
For staged cases, document the intent to reimplant at a future date so modifier 58 is defensible on the second procedure.
Approach and soft tissue management should be described by name — audit teams flag notes that reference only 'standard approach.'

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 52 Reduced services 57 Decision for surgery 58 Staged or related 62 Co-surgeons 74 Discontinued post-anesthesia 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 24160 covers explantation of a failed or infected total elbow arthroplasty — specifically both the humeral stem and the ulnar component. Debridement and synovectomy, when performed as part of that same removal session, are bundled into this code and cannot be billed separately.

The 90-day global period applies. All routine post-op care from the day before surgery through day 90 is included. If you're managing a periprosthetic infection and staging the case — removal followed later by reimplantation — the reimplantation is a staged procedure and requires modifier 58. An antibiotic spacer placed at the same operative setting as the removal has been debated in coding forums; document the spacer placement and the clinical rationale distinctly, as some payers treat it as a separately reportable service.

Not separately billable: if the surgeon proceeds directly to reimplantation (24361 or 24363) in the same session, NCCI policy explicitly bundles 24160 into those arthroplasty codes. Do not append modifier 59 to unbundle — the removal is considered inclusive to the replacement procedure. Bill 24160 only when removal is the definitive endpoint of that operative encounter.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	18.16
Practice expense RVU	12.34
Malpractice RVU	3.88
Total RVU	34.38
Medicare national rate	$1,148.32
Global period	90 days

Payment by site of service

Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.

Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026

Setting	Medicare rate (national)
Office (PFS non-facility) Procedure performed in physician's office	$1,148.32
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI A2) Ambulatory surgical center (freestanding)	$1,644.87

Common denial reasons

The recurring reasons claims for CPT 24160 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

24160 billed with 24361 or 24363 on the same date — NCCI bundles removal into those replacement codes with no modifier override.
Only one component documented in the operative note when both humeral and ulnar removal are required to support this code.
Missing staged-procedure modifier 58 on reimplantation claim, causing the second surgery to deny as a duplicate or global-period service.
Diagnosis code does not support medical necessity for full prosthesis removal (e.g., vague 'elbow pain' without documented implant failure or infection).
Modifier 78 applied incorrectly to a planned staged reimplantation — modifier 58 is correct for planned staged procedures; 78 is for unplanned returns for a related complication.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01Can I bill 24160 when the surgeon removes the old implant and immediately places a new one in the same session?

No. NCCI policy explicitly bundles 24160 into 24361 and 24363 when replacement occurs in the same operative session. Bill only the reimplantation code. Appending modifier 59 to unbundle is incorrect and will trigger NCCI edits.

02What modifier do I use for a planned staged reimplantation after 24160?

Use modifier 58 on the reimplantation claim. The removal was stage one; the reimplantation is a staged, related procedure. Modifier 78 would be wrong here — 78 is for an unplanned return to the OR for a complication of the original procedure.

03Is debridement or synovectomy at the same session separately billable with 24160?

No. When performed as part of the removal procedure, debridement and synovectomy are bundled into 24160 by definition. Billing them separately will generate an NCCI edit.

04Does the 90-day global period apply to 24160?

Yes. 24160 carries a 90-day global. Routine post-op visits, wound care, and stitch removal within that window are included. Unrelated services in the global period need modifier 24; a new problem requiring a significant, separately identifiable E/M needs modifier 25.

05Can 24160 be billed for removal of only the humeral component, leaving the ulnar component in place?

No. 24160 requires removal of both the humeral and ulnar components. If only one component is removed, the code does not apply — document exactly which component(s) were explanted and select the most accurate available code.

06How should I code an antibiotic spacer placed during the same session as prosthesis removal?

Document the spacer placement as a distinct surgical step with its own rationale. Payer coverage for separately billing the spacer varies — some payers bundle it, others allow it with modifier 59 or XS. Verify payer-specific policy before billing.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira AI Scribe

Mira's AI scribe captures the removal of both humeral and ulnar prosthetic components, any debridement or synovectomy performed, the indication (loosening, infection, fracture), and whether a spacer was placed — all from surgeon dictation. That specificity prevents the most common denial: a note that documents removal of only one component, which fails to support 24160 and triggers a down-code or rejection.

See how Mira captures CPT 24160 documentation